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Elevated serum IgG4 is associated with chronic antibiotic-refractory pouchitis
Udayakumar Navaneethan1, Preethi G K Venkatesh, Sumit Kapoor
1Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Summary
Elevated serum IgG4 levels were found in 8% of patients with ileal pouch disorders. These patients showed a higher likelihood of developing chronic antibiotic-refractory pouchitis (CARP).
Area of Science:
- Gastroenterology
- Immunology
- Inflammatory Bowel Disease
Background:
- Mucosal infiltration of IgG4-expressing plasma cells was previously observed in chronic antibiotic-refractory pouchitis (CARP).
- The role of serum IgG4 in ileal pouch disorders remains uninvestigated.
- IgG4-mediated autoimmunity is hypothesized as a potential factor in CARP pathogenesis.
Purpose of the Study:
- To determine the prevalence of elevated serum IgG4 in symptomatic ileal pouch patients.
- To characterize the clinical features of pouch disorders associated with high serum IgG4.
- To explore the association between serum IgG4 levels and specific pouch pathologies like CARP.
Main Methods:
- 124 symptomatic ileal pouch patients were enrolled between January and October 2010.
- Serum IgG4 levels were measured at presentation.
- Demographic, clinical, and laboratory data were compared between patients with elevated serum IgG4 (≥112 mg/dl) and controls (<112 mg/dl).
Main Results:
- 8% of patients (10 out of 124) had elevated serum IgG4.
- The median serum IgG4 was significantly higher in the study group (144.5 mg/dl) compared to controls (14 mg/dl).
- Elevated serum IgG4 was significantly associated with a higher incidence of CARP (50.0% vs. 20.2%, p=0.03).
Conclusions:
- Approximately 8% of symptomatic ileal pouch patients exhibit elevated serum IgG4.
- Elevated serum IgG4 is more common in patients with CARP.
- Further research into IgG4-mediated autoimmunity in ileal pouch disorders is warranted.
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